Publications by authors named "Mesut Sancar"

37 Publications

Turkish community pharmacists' behavioral determinants in provision of pharmaceutical care to elderly patients.

Int J Clin Pharm 2021 Jan 7. Epub 2021 Jan 7.

Clinical Pharmacy Department, Faculty of Pharmacy, Marmara University, Maltepe, Istanbul, Turkey.

Background It is crucial to develop and implement community pharmacist-led pharmaceutical care services in primary care that could prevent and detect potentially inappropriate prescribing and promote medication adherence in older patients. Objective The aim of this study was to determine community pharmacists' perceived barriers and facilitators face during the provision of pharmaceutical care to older patients by using a theoretical domains framework. Method A cross-sectional online survey was conducted among community pharmacists in Turkey. A Turkish version of the 50-item Determinants of Implementation Behavior Questionnaire was developed to evaluate behavioral determinants of community pharmacists on delivering pharmaceutical care to older patients. Main outcome measures The behavioral determinants of community pharmacists. Results A total of 354 community pharmacists answered the questionnaire. The mean age was 43.2 (standard deviation = 11.1), and 227 (64%) of the pharmacists were female. Community pharmacists' positive opinions on pharmaceutical care service outcomes in older patients and feedback were regarded as facilitators. Community pharmacists' motivational level and emotions were additional determinant facilitators in delivering pharmaceutical care to older patients. Their negative opinions on the impact and action of pharmaceutical care in older patients were regarded as barriers. Conclusion In primary health care, a theory-based e-distant training program for community pharmacists and the guidelines for standard pharmaceutical care services led by community pharmacists could be designed by addressing barriers related to the impact and action of pharmaceutical care in older patients.
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http://dx.doi.org/10.1007/s11096-020-01211-0DOI Listing
January 2021

Evaluation of medication dose adjustments in patients with impaired renal function using different online drug information databases.

Eur J Hosp Pharm 2020 Oct 28. Epub 2020 Oct 28.

Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey.

Objectives: Clinical pharmacist-led medication dose adjustment is required to provide safe and effective pharmacotherapy in patients with impaired renal function. This study aimed to assess clinical pharmacist-led medication dose adjustments in hospitalised patients with impaired renal function by comparing three online drug information databases.

Methods: This retrospective observational study was conducted in an internal medicine ward between November 2016 and February 2017 among hospitalised patients with at least one estimated glomerular filtration rate (eGFR) value <60 mL/min/1.73 m. Clinical pharmacist-led medication dose adjustments according to eGFR were performed by comparing three online drug information databases: Micromedex, Medscape and Lexicomp. The number of items related to dose adjustments detected during the study period and the concordance between databases were evaluated.

Results: This study was conducted among 100 hospitalised patients (mean age 74.6±13.2 years) with impaired renal function. Clinical pharmacists detected at least one medication dose adjustment in 71.0% of patients. Among these patients, it was found that physician-led medication dose adjustments were made in only 15.5% of them. Of 1053 medications, the number of medications that required dose adjustments were 149 (14.2%), 151 (14.3%) and 163 (15.5%) according to Micromedex, Medscape and Lexicomp, respectively. The Fleiss kappa coefficient was 0.875 and the agreement of the three clinical decision support systems were almost perfect.

Conclusions: In renal dose adjustments, Micromedex, Lexicomp and Medscape are concordant as online drug information databases. Clinical pharmacists could detect medication dose adjustment requirements in hospital patients with impaired renal function. The potential positive impact of clinical pharmacist-led medication dose adjustment should be investigated in further studies.
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http://dx.doi.org/10.1136/ejhpharm-2020-002395DOI Listing
October 2020

Polypharmacy, potentially inappropriate prescribing and medication complexity in Turkish older patients in the community pharmacy setting.

Acta Clin Belg 2020 Oct 8:1-7. Epub 2020 Oct 8.

Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University , Istanbul, Turkey.

Objective: This study aimed to evaluate polypharmacy, potentially inappropriate prescribing (PIP) and medication complexity in Turkish older patients in the community pharmacy setting and to determine the factors associated with PIP.

Methods: This descriptive cross-sectional study was conducted in the community pharmacy setting in Istanbul. Older patients (≥65 years old) who chronically used at least one medication and visited the community pharmacy for any reason in the past 4 months were invited in this study. PIP was determined by using the Ghent Older People's Prescriptions Community Pharmacy Screening (GheOPS)-tool. The Turkish version of the Medication Regimen Complexity Index (MRCI) was used to determine medication complexity.

Results: Polypharmacy (defined as the concurrent use of five or more medications) was found in 69.0% of 158 patients. A total of 398 PIPs were detected and 83.5% (n = 132) of older patients had at least one PIP. The median (IQR) MRCI score was 12.5 (7.0-19.6). The factors associated with having ≥2 PIP were advanced age (≥75 years old) (OR = 2.87, 95% CI 1.41-5.81; < 0.05), higher number of chronic diseases (when ≥3, OR = 8.51, 95% CI 3.66-19.76; < 0.05), receiving polypharmacy (OR = 8.92, 95% CI 4.09-19.46; < 0.05), and higher MRCI scores (when MRCI ≥12.5, OR = 4.40, 95% CI 2.22-8.71; < 0.05).

Conclusion: More than half of the Turkish older patients had polypharmacy and the rate of PIP was high. A higher number of PIP was associated with advanced age, higher number of chronic diseases, polypharmacy, and more complex medication regimens.
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http://dx.doi.org/10.1080/17843286.2020.1829251DOI Listing
October 2020

Comparison of non-burn-specific systemic inflammatory response syndrome criteria and burn-specific American Burn Association systemic inflammatory response syndrome criteria in paediatric burned patients.

J Paediatr Child Health 2020 10 25;56(10):1623-1628. Epub 2020 Aug 25.

Faculty of Pharmacy, Department of Clinical Pharmacy, Marmara University, Istanbul, Turkey.

Aim: We aim to investigate the diagnostic value of newly defined criteria for the systemic inflammatory response syndrome (SIRS) for paediatric burn patients by the American Burn Association (ABA) by comparing the non-burn-specific SIRS criteria for children.

Methods: A total of 147 paediatric burn patients were included in this study. Patients diagnosed with sepsis were included in the sepsis group. Clinical parameters were obtained from the electronic medical records at the time of preliminary sepsis diagnosis. Both the non-burn-specific SIRS criteria and the burn-specific ABA SIRS criteria were applied to both the sepsis group and the non-sepsis group.

Results: Of 147 patients, 50 had sepsis according to the non-burn-specific sepsis criteria. When the 50-patient sepsis group was compared to the 97-patient non-sepsis group, the sepsis group had a significantly higher duration of hospitalisation, burn percentage, burn state and abbreviated burn scoring index (ABSI) (P < 0.05). The specificity of the two scales was 29.9% for the non-burn-specific SIRS and 74.2% for the burn-specific ABA SIRS. The sensitivity for the burn-specific ABA SIRS was calculated as 58%, the sensitivity for the non-burn-specific SIRS was 100%. While positive predictive value was calculated as 42.4% for the non-burn-specific SIRS, this value was found as 53.7% for the burn-specific ABA SIRS criteria. The correlation coefficient between the non-burn-specific SIRS and the burn-specific ABA SIRS was 0.378 (P < 0.001).

Conclusions: Our study underlines the need for widespread use of more specific and sensitive burn-specific clinical criteria to early diagnosis of infection in burn patients to prevent unnecessary antibiotic usage.
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http://dx.doi.org/10.1111/jpc.15060DOI Listing
October 2020

Aprepitant in the Treatment of Subacute Sclerosing Panencephalitis: A Randomized, Double-Blind, Placebo-Controlled Study.

Pediatr Neurol 2020 09 1;110:59-63. Epub 2020 Jun 1.

Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey.

Background: Aprepitant is a neurokinin-1 receptor antagonist approved for the treatment of chemotherapy-induced nausea. We aimed to investigate the safety and efficacy of aprepitant in patients with subacute sclerosing panencephalitis.

Methods: A randomized, double-blind, placebo-controlled study was conducted in patients with subacute sclerosing panencephalitis assigned to receive two courses of aprepitant 250 mg/day orally or placebo for 15 days with an interval of two months between courses. Primary end points were safety and tolerability, and secondary end point was clinical improvement or stabilization assessed by subacute sclerosing panencephalitis scoring system. Electroencephalography (EEG), brain magnetic resonance imaging, and cerebrospinal fluid measles-specific immunoglobulin G index were evaluated before and after treatment.

Results: Sixty-two patients with subacute sclerosing panencephalitis were allocated to aprepitant (n = 31, median age 18 years) or placebo (n = 31, median age 22 years) group. Fifteen patients left the study within the first six months and 12 patients left between six and 12 months. Aprepitant was well tolerated and treatment-associated adverse events were similar to those described in the treatment of nausea. Clinical status at six and 12 months' follow-up did not differ between aprepitant and placebo groups. Post-treatment EEG scores at 12 months were better in the aprepitant group (P = 0.015). Cerebral atrophy on magnetic resonance imaging increased in both groups, whereas measles-specific immunoglobulin G index decreased in the placebo group.

Conclusions: In this first clinical trial of aprepitant treatment in patients with subacute sclerosing panencephalitis, the drug was safe and well tolerated. No clinical effect was observed. A modest improvement in EEG findings might justify trials for longer periods because EEG changes can precede clinical findings in subacute sclerosing panencephalitis.
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http://dx.doi.org/10.1016/j.pediatrneurol.2020.05.009DOI Listing
September 2020

Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting.

Eur J Cancer Care (Engl) 2020 Sep 15;29(5):e13261. Epub 2020 Jun 15.

Oncology Centre, Dr. Lütfi Kırdar Kartal Teaching and Research Hospital, Istanbul, Turkey.

Introduction: The simultaneous occurrence of diabetes and cancer may complicate the management of both conditions resulting in poor prognosis and more deterioration of patient-related outcomes.

Objective: To assess the effective provision of clinical pharmacy services and pharmacist-led counselling program on improving patient-related outcomes among patients with diabetes and newly diagnosed with cancer during chemotherapy administration.

Methods: A single-centre, prospective, randomised, controlled study was carried out on patients with diabetes newly diagnosed with cancer during chemotherapy administration at the outpatient oncology setting. Patients were assigned as a normal care group receiving only normal care by the oncology care providers and an intervention group receiving both normal and clinical pharmacy care through an extensive oral and written patient education, pharmacotherapy optimisation and regular recommendations for diabetic self-care activities with three-month follow-up.

Results: Patients within the intervention group showed a better glycaemic control (p = .049), a significant increase in medication adherence (p = .0049), a significant increase in diabetes self-care activities, including diet (p = .037), self-monitoring of blood glucose (p = .027) and foot care (p = .0085) and reported a lower deterioration in quality of life.

Conclusion: Patients with diabetes and cancer receiving chemotherapy experienced improved patient-related outcomes after clinical pharmacy intervention and counselling program compared to the normal care group.
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http://dx.doi.org/10.1111/ecc.13261DOI Listing
September 2020

Evaluation of QuantiFERON tuberculosis Gold In-Tube assay for diagnosis of active tuberculosis in children.

J Paediatr Child Health 2020 Apr 12;56(4):581-585. Epub 2019 Nov 12.

Duzen Laboratories Group, Department of Microbiology, Division of Tuberculosis Laboratory, Istanbul, Turkey.

Aim: Tuberculin skin test (TST) is still used in diagnostic algorithms of childhood tuberculosis (TB). QuantiFERON TB Gold In-Tube assay (QFT-GIT) is an alternative test to TST based on the detection of interferon-gamma release upon in vitro induction of peripheral mononuclear cells by TB antigens. In this study, we aimed to determine the diagnostic value and performance of QFT-GIT for active childhood TB.

Methods: This retrospective study was conducted between January 2005 and December 2011 in three referral hospitals in Turkey with 124 children who were diagnosed with definite active TB. Sensitivity values of TST and QFT-GIT were determined by accepting the microbiological confirmation as the gold standard of diagnosis of TB.

Results: In our study, sensitivity of QFT-GIT and TST was found to be 65 and 66% respectively. However, combined usage of QFT-GIT and TST was found to be more sensitive (85%) than TST or QFT-GIT alone (P < 0.0001). Although negative results of QFT-GIT or TST did not exclude the diagnosis of active TB in children, their positivity supported the diagnosis. Specificity could not be measured as only microbiologically confirmed cases of Mycobacterium tuberculosis disease were enrolled in the study.

Conclusion: Although sensitivities of TST and QFT-GIT are too low to exclude active TB, their positivity supports diagnosis of active TB in children concomitant with signs and symptoms. QFT-GIT and TST should be used together to enhance diagnostic sensitivity and could help exclude a diagnosis of TB if the pretest probability is low.
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http://dx.doi.org/10.1111/jpc.14687DOI Listing
April 2020

Evaluation of satisfaction and internet self-efficacy of inquirers using an internet-based drug information centre.

J Taibah Univ Med Sci 2019 Feb 12;14(1):67-72. Epub 2018 Dec 12.

Clinical Pharmacy, University of Marmara Faculty of Pharmacy, Istanbul, Turkey.

Objectives: This study aimed to evaluate the satisfaction level of inquirers of an internet-based drug information centre along with the internet usage abilities and habits of individuals who had previously utilised services from an internet-based drug information centre in Turkey.

Methods: The first 100 individuals who received medication consultancy from the webpage entitled "www.ilacpedia.com" and consented to participate in the study were included in this study. This website is an internet-based drug information centre. Participants' data were collected using a participant data form and the Internet Self-efficacy Scale.

Results: The mean age of participants was 37.92 ± 12.32 years (71 female). It was found that 89% of the individuals who received pharmaceutical consultation from the internet-based drug information service believed that the information that they received was enough to solve their problem. The internet self-efficacy scale scores indicated the highest score on the decomposition subscale (20.94 ± 6.18) and the lowest on the communication subscale (9.77 ± 3.57).

Conclusions: The present study revealed that the internet-based drug information service provided by clinical pharmacists contributed positively to users' satisfaction, thus indicating the importance of the involvement of clinical pharmacists in this process.
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http://dx.doi.org/10.1016/j.jtumed.2018.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695055PMC
February 2019

Effects of dapagliflozin in experimental sepsis model in rats.

Ulus Travma Acil Cerrahi Derg 2019 May;25(3):213-221

Department of Clinical Pharmacy, Marmara University Faculty of Pharmacy, İstanbul-Turkey.

Background: The aim of this study was to evaluate the possible protective effects of dapagliflozin in an experimental sepsis model in rats.

Methods: Saline (1 mL/kg, p.o.) or dapagliflozin (10 mg/kg, p.o.) was administered to Sprague-Dawley rats for 5 days prior to the surgical procedures. Under anesthesia, sepsis was induced by cecal ligation puncture, while sham control groups underwent laparotomy only. Blood urea nitrogen, creatinine, and glucose levels were measured in serum samples and the levels of malondialdehyde (MDA), glutathione (GSH), myeloperoxidase (MPO), tumor necrosis factor alpha, interleukin 1 beta, caspase 8, and caspase 9 were determined in tissue samples (kidney, liver, and lung). Histological evaluation was also performed.

Results: The administration of dapagliflozin in a sepsis model reduced oxidative stress (MDA), increased antioxidant levels (GSH), and reduced inflammation (MPO) in the kidney (p<0.05). Dapagliflozin also decreased oxidative stress (MDA) in lung tissue and decreased inflammation (MPO) in lung and liver tissue (p<0.05). Caspase 8 and 9 levels in kidney, lung, and liver tissue were increased (p<0.05) in the dapagliflozin group compared with the sepsis group. According to the histopathological results, sepsis was moderately improved in renal tissue and slightly attenuated in lung and liver tissue with the administration of dapagliflozin.

Conclusion: Dapagliflozin had a preventive effect on sepsis-induced kidney damage, but the protective effect was mild in lung and liver tissue in the present study.
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http://dx.doi.org/10.5505/tjtes.2018.82826DOI Listing
May 2019

Determination of Potential Drug-Drug Interactions Using Various Software Programs in a Community Pharmacy Setting.

Turk J Pharm Sci 2019 Mar 31;16(1):14-19. Epub 2018 Dec 31.

Bezmialem University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Turkey.

Objectives: The aim of the present study was to compare various software programs in detecting potential drug-drug interactions in a community pharmacy setting.

Materials And Methods: Details of prescriptions were collected from 50 community pharmacies located in İstanbul in March and April 2015 (two days per week). From each pharmacy, the first 20 prescriptions that included more than one drug were collected to evaluate potential drug-drug interactions. The following software programs were utilized to detect potential drug-drug interactions: micromedexsolutions.com, medscape.com, and drugs.com. The number of potential interactions detected by the software programs was determined.

Results: At least one potential drug-drug interaction was detected in 39.2% of the 1000 prescriptions by one of the software programs. According to the rates of total drug-drug interactions gathered from various software programs, these programs gave the following results: medscape.com 33.3%, drugs.com 31.3%, and micromedexsolutions.com 21.2%.

Conclusion: After comparing different software programs, the potential drug-drug interactions found by the programs proved to be different. Therefore, we recommend that pharmacists confirm with a different program before making a decision when they detect clinically significant potential drug-drug interactions.
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http://dx.doi.org/10.4274/tjps.30932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227974PMC
March 2019

Evaluation of potentially inappropriate medication utilization in elderly patients with cancer at outpatient oncology unit.

J Oncol Pharm Pract 2019 Sep 25;25(6):1321-1327. Epub 2018 Jul 25.

1 Department of Clinical Pharmacy, Marmara University Faculty of Pharmacy, Istanbul, Turkey.

Background: The aim of the study was to evaluate potentially inappropriate medication use in elderly patients with cancer.

Method: This study was conducted at outpatient oncology clinic from December 2014 to March 2015 among elderly cancer patients. Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria were used to identify potentially inappropriate medication in elderly patients.

Results: Among 114 cancer patients 55.26% of them were male and the mean age of them was 71.78 ± 5.50 (years). The most common concurrent diseases were hypertension in 45 (39.47%) and diabetes in 26 (22.81%) patients. Polypharmacy (≥5 medications) was seen in 94.73% of them. Eighteen patients (15.79%) utilized medications inappropriately according to Screening Tool of Older Person's Prescriptions criteria. Medication omissions were identified in 112 patients (98.25%) with Screening Tool to Alert doctors to Right Treatment criteria.

Conclusions: Clinical pharmacists could improve the current prescribing practices in elderly patients with cancer by assessing potentially inappropriate medications.
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http://dx.doi.org/10.1177/1078155218788698DOI Listing
September 2019

Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer.

Eur J Hosp Pharm 2018 Mar 10;25(e1):e17-e20. Epub 2017 Mar 10.

Department of Internal Medicine, Division of Medical Oncology, Marmara University Medical School, Istanbul, Turkey.

Objective: To determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer.

Methods: 36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the study. The patients were followed up during 3 courses of chemotherapy and individual pharmaceutical care plans were developed. The quality of life of patients was evaluated before and after the third course of chemotherapy.

Results: The incidence of drug-related problems (DRPs) in chemotherapy-treated patients was reduced in the 3rd course as compared with 1st course (63.9% vs 75%, respectively; n=36; p>0.05). The clinical oncology pharmacist gave 147 recommendations to patients, which were followed in 98% (n=144) of cases. 91.7% (n=132) of the recommendations of clinical oncology pharmacists solved the drug-related problems; however, the remaining 8.3% (n=12) did not solve the problems and the patients were referred to a doctor for further investigations. The symptom-related quality of life of patients related to anaemia, diarrhoea and neurotoxicity was reduced after the third course of chemotherapy (p<0.05).

Conclusions: The pharmaceutical care provided by the clinical oncology pharmacist has an important role in the identification and resolution of DRPs. Evaluation of symptom-related quality of life is important for the monitoring of patients receiving chemotherapy.
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http://dx.doi.org/10.1136/ejhpharm-2016-001188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457159PMC
March 2018

Drug related problems identified by clinical pharmacist at the Internal Medicine Ward in Turkey.

Int J Clin Pharm 2018 Apr 29;40(2):360-367. Epub 2018 Jan 29.

Clinical Pharmacy Department, School of Pharmacy, Marmara University, Istanbul, Turkey.

Background Drug-related problems (DRPs) interfere with patient optimal therapeutic outcomes and may be associated with higher morbidity, mortality and healthcare expenditures. Objective This study aimed to identify DRPs and their causes in a Turkish hospital. Setting Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Internal Medicine Ward, Istanbul, Turkey. Method Cross-sectional study included a total of 100 patients. Patient demographics, medications, and history were evaluated. Data regarding recent medications were analyzed by two clinical pharmacists and an Internal Medicine physician. The DRPs were identified via V7.0 PCNE classification. Lexicomp was used to assess the drug-drug interactions. UpToDate recommendations and national guidelines were applied in the assessment of compliance with approved medication procedures. Main outcome measures Number and causes of the potential DRPs. Results At least one potential DRP was seen in 80% of the patients and 163 potential DRPs were identified (average = 1.6 DRPs/patient). The most common causes of DRPs were errors in drug selection (44.78%), dose selection (27.61%) and medication procedures (21.47%). There were significant correlations (p < 0.05) between DRPs and age (r = 0.4), number of drugs used (r = 0.32), duration of hospitalization (r = 0.25), renal impairment (r = - 0.34) and inflammation (r = 0.31). Conclusion The majority of the patients had DRPs. Patients with renal impairment, inflammation, polypharmacy or an extended hospital stay had a much higher chance of developing DRPs.
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http://dx.doi.org/10.1007/s11096-017-0585-5DOI Listing
April 2018

Comparison of conditioning regimen toxicities among autologous stem cell transplantation eligible multiple myeloma patients: High-dose melphalan versus high-dose melphalan and bortezomib.

J Oncol Pharm Pract 2018 Jun 21;24(4):281-289. Epub 2017 Mar 21.

2 Department of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey.

Background Autologous hematopoietic stem cell transplantation (AHSCT) remains the standard of care for younger patients with multiple myeloma (MM). Currently, high-dose melphalan (HDM) is recommended as conditioning regimen before AHSCT. Preclinical data suggest that combining bortezomib and melphalan has synergistic effect against multiple myeloma cells. Bortezomib and HDM (Bor-HDM) combination as conditioning regimen has been investigated by many other investigators. Objective In this retrospective study, we aimed to compare transplant-related toxicities and hematologic recovery of HDM and Bor-HDM conditioning regimens. Method We retrospectively evaluated hematologic recovery and toxicity profile in patients with MM who received AHSCT with either HDM ( n = 114) or Bor-HDM ( n = 53) conditioning regimen. Results Nonhematologic toxicities were comparable between HDM and Bor-HDM conditioning regimen, except mucositis and diarrhea being more frequent in the Bor-HDM group. Neutrophil and platelet engraftment time and duration of hospital stay were significantly shorter for HDM regimen. Conclusions In this retrospective analysis, we observed engraftment kinetics and duration of hospitalization were significantly worse in Bor-HDM conditioning regimen with manageable toxicities. Randomized studies are needed to further compare Bor- HDM regimen to HDM in terms of response rates, toxicities, and transplant-related mortality.
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http://dx.doi.org/10.1177/1078155217697486DOI Listing
June 2018

Protective effect of ferulic acid on cisplatin induced nephrotoxicity in rats.

Environ Toxicol Pharmacol 2017 Sep 1;54:105-111. Epub 2017 Jul 1.

Clinical Pharmacy Department, Marmara University, Faculty of Pharmacy, Istanbul, Turkey. Electronic address:

This study aims to determine the potential protective effects of ferulic acid against cisplatin-induced nephrotoxicity and to compare its effect with curcumin, a well-known protective agent against cisplatin- induced toxicity in rats. Administration of cisplatin resulted in high BUN (Blood Urea Nitrogen), creatinine, MDA (Malondialdehyde), MPO (Myeloperoxidase), TOS (Total Oxidative Status), PtNT (Protein Nitrotyrosine) levels (p<0.05). Histological observations showed abnormal morphology of kidney; in addition with appearance of TUNEL positive cells indicating apoptosis in cisplatin administered group. HO-1 (Heme Oxygenase-1) levels measured by RT-PCR (Real Time Polymerase Chain Reaction), and TAS (Total Antioxidative Status) revealed antioxidant depletion due to cisplatin toxicity in animals (p<0.05). All parameters showed improvement in groups treated with ferulic acid (p<0.05). Ferulic acid treatment was found significant in preventing oxidative stress, increasing antioxidative status and regaining histological parameters to normal, indicating nephroprotective and antioxidant effects of this phenolic compound.
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http://dx.doi.org/10.1016/j.etap.2017.06.026DOI Listing
September 2017

Effect of a Pharmacist-Led Program on Improving Outcomes in Patients with Type 2 Diabetes Mellitus from Northern Cyprus: A Randomized Controlled Trial.

J Manag Care Spec Pharm 2017 May;23(5):573-582

3 Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey.

Background: The management of type 2 diabetes mellitus is complex, requiring continuous medical care by health care professionals and considerable self-care efforts by patients. Pharmacist-led care programs have been shown to help patients with diabetes succeed in achieving treatment goals and improving outcomes. Pharmacist-led care is a new health care concept in Northern Cyprus.

Objective: To evaluate the effect of a pharmacist-led care program on glycemic control, determined by hemoglobin A1c (A1c), and secondarily on blood pressure, lipid profile, body mass index (BMI), waist circumference, medication adherence, and self-care activities, for patients with type 2 diabetes over a 12-month period.

Methods: This was a prospective, randomized controlled study conducted in a public hospital's outpatient diabetes clinic, with 152 patients who had been diagnosed with type 2 diabetes. Of these, 75 patients were in the intervention group, and 77 patients were in the usual care group. The intervention group participated in a pharmacist-led care program with a clinical pharmacist who provided 5 face-to-face educational sessions over a period of 12 months. The main outcome measure was change in A1c, and secondary outcome measures were changes in fasting blood glucose, systolic and diastolic blood pressure, lipid values (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and serum levels of triglycerides [TGs]), BMI, waist circumference, self-reported medication adherence (Morisky-Green test), and self-care activities. Changes in outcome measures from baseline to the end of the study were assessed using the Mann-Whitney U-test and Wilcoxon test.

Results: At the end of the 12-month study period, the intervention patients showed a greater reduction in A1c values than the usual care patients (-0.74% vs. -0.04%; P < 0.001). Both groups showed significant reductions in fasting blood glucose levels between baseline and the end of 12 months; the difference between the groups was statistically nonsignificant (P = 0.410). When comparing the intervention and usual care groups, there was a significant decrease in systolic (P = 0.01) and diastolic blood pressure (P = 0.04) at the end of the trial. No significant differences were found between the groups in LDL-C, HDL-C, or TG values; however, total cholesterol levels did decrease significantly (P = 0.063, 0.331, 0.896, and 0.04, respectively). Significant reductions occurred in BMI (P < 0.001) and waist circumference (P < 0.001), and improvements were observed in self-reported medication adherence and self-care activities in the intervention group.

Conclusions: A clinical pharmacist-led care program in a public hospital's outpatient diabetes clinic was associated with significant improvements in reducing A1c and other secondary outcomes in a 12-month randomized controlled study.

Disclosures: This study was conducted as a PhD thesis by Korcegez under the supervision of Sancar for the clinical pharmacy program at Near East University, Health Sciences Institute, Northern Cyprus, and received no external funding. The authors have no potential conflicts of interest to report. Study concept and design were contributed by Korcegez, with assistance from Sancar and Demirkan. Korcegez took the lead in data collection, and data interpretation was performed by Korcegez, along with Sancar and Korcegez. The manuscript was written and revised by Korcegez, along with Sancar, and with assistance from Demirkan.
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http://dx.doi.org/10.18553/jmcp.2017.23.5.573DOI Listing
May 2017

Impact of adherence to antiemetic guidelines on the incidence of chemotherapy-induced nausea and vomiting and quality of life.

Int J Clin Pharm 2016 Dec 28;38(6):1464-1476. Epub 2016 Oct 28.

Molecular Medicine Department, Division of Hospital Management, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.

Background International guidelines are tools enabling physicians to incorporate the latest evidence based clinical information into practice. Objective This study aimed to evaluate the impact of antiemetic guidelines adherence on the incidence of chemotherapy-induced nausea and vomiting (CINV) and patient quality of life. Setting Marmara University Pendik Training and Research Hospital chemotherapy unit, Istanbul, Turkey. Method The study included 100 chemotherapy naive patients. Antiemetic prescribing patterns and their consistency with MASCC/ESMO 2014 guidelines were assessed. Patients recorded incidences of vomiting in a daily dairy and described their nausea using a 7-item Likert Scale. The incidence of CINV was recorded over five days. To assess the patient's quality of life, a modified Turkish version of the Functional Living Index-Emesis (FLIE) questionnaire was administered before and after receiving chemotherapy. A questionnaire on the existence and severity of side effects was developed and administered. Main outcome measures Incidence of side effects on CINV and quality of life according to the FLIE. Results The primary outcome revealed differences in complete control (no emetic episodes, rescue therapy or nausea), FLIE scores and side effects. Guidelines consistency was observed more with acute (A) than with delayed (D) prevention of CINV, with significant differences in complete control between the guideline adherent group (GAG) and the guideline nonadherent group (GNG). Significant differences in the FLIE score were noticed between GAG(D) and GNG(D), and GNG(D) had a higher incidence of diarrhoea, headache, swallowing difficulties and dark-coloured stool. Conclusion Consistency with guidelines resulted in significant reduction in the incidence of both cute and delayed CINV and other side effects, and with improvement of the patient quality of life.
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http://dx.doi.org/10.1007/s11096-016-0393-3DOI Listing
December 2016

Ethanol extract of Cotinus coggygria leaves accelerates wound healing process in diabetic rats.

Pharm Biol 2016 Nov 14;54(11):2732-2736. Epub 2016 May 14.

c Department of Clinical Pharmacy , Marmara University , İstanbul , Turkey.

Context: Cotinus coggygria Scop. (Anacardiaceae) leaves that were used as wound healing in traditional Balkan and Anatolian folk medicine, could be potentially effective in treating diabetic wounds.

Objective: This study investigates biochemical and histological effects of ethanol extract of C. coggygria (CCE) on excision wound model in diabetic rats.

Materials And Methods: This study was conducted on diabetic Wistar albino rats, which were injected by a single dose (50 mg/kg i.p.) streptozotocin. Afterward an excision wound model was created in all animals; diabetic control rats were applied topically simple ointment and diabetic treatment rats were applied topically 5% (w/w) ointment with CC, once a day during the experimental period. Malondialdehyde, glutathione and hydroxyproline levels in wound tissues were investigated at the end of 3rd, 7th, and 14th days. Histopathological examination was also performed.

Results: Hydroxyproline content was significantly increased in the CCE treated group versus control after the 3rd and 7th days (15.33 versus 11.83; 19.67 versus 15.67 mg/g, p < 0.05; respectively). A statistically significant elevation in glutathione at the end of 3rd, 7th, and 14th days (5.13 versus 1.58, p < 0.05; 4.72 versus 1.88, p < 0.05; 3.83 versus 1.88 μmol/g, p < 0.05, respectively) and a statistically significant decrease in malondialdehyde level at the end of 7th day (4.49 versus 1.48 nmol/g, p < 0.05) were determined in the treated group versus control group. These results were also supported by histological analyses.

Discussion And Conclusion: These findings indicate that CCE accelerated the cutaneous wound healing process in diabetic wounds, in confirmation of its traditional use.
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http://dx.doi.org/10.1080/13880209.2016.1181660DOI Listing
November 2016

Validation of the Turkish version of medication regimen complexity index among elderly patients.

J Eval Clin Pract 2016 Oct 14;22(5):732-6. Epub 2016 Mar 14.

Clinical Pharmacy Department, Marmara University, Faculty of Pharmacy, Istanbul, Turkey.

Objective: The aim of this study was to validate the Turkish version of the 'Medication Regimen Complexity Index' (MRCI).

Methods: This validation study has been conducted in prescriptions of the first 100 elderly patients who had visited the pharmacy for their prescription refill to evaluate convergent and divergent validity of the Turkish version. The reliability of the Turkish version was assessed with inter-rater and test-retest analysis after its translation and cultural adaptation.

Results: The mean age of the 100 patients (53 women) was 74.9 years (SD = 7.58, 65-95). The scale showed high inter-rater reliability and test-retest reliability for the total and subscale scores (p < 0.05). A strong and positive correlation between the number of medications in a prescription and the total Medication Regimen Complexity Index scores (r = 0.930, p < 0.001) was determined. There were no statistically significant differences between age, gender and MRCI scores (p > 0.05).

Conclusion: These results show that the Turkish version of MRCI is a reliable and valid tool in elderly patients.
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http://dx.doi.org/10.1111/jep.12526DOI Listing
October 2016

Adverse drug reactions due to drug-drug interactions with proton pump inhibitors: assessment of systematic reviews with AMSTAR method.

Expert Opin Drug Saf 2016 5;15(2):223-36. Epub 2016 Jan 5.

b Marmara University , Clinical Pharmacy, Faculty of Pharmacy , Istanbul , Turkey.

Introduction: Many systematic reviews resulted in claims on drug-drug interactions (DDIs) with proton pump inhibitors (PPIs). Such a large number begs for consensus on the clinical significance of findings.

Areas Covered: We critically evaluated the safety of PPI use with respect to DDIs with a meta-review of systematic reviews published between 1978 and 2015. We assessed the evidence by their reliability, repeatability, transparency, and objectivity according to the Assessment of Multiple Systematic Reviews (AMSTAR) criteria.

Expert Opinion: Clinicians must assess risks for each PPI for certain comorbid conditions. DDIs don't substantiate class effect for PPIs; each PPI could induce unique DDIs. Concomitant use of PPIs with thienopyridines (e.g. clopidogrel) could be justified in patients without strong affinity to cytochrome CYP2C19 and with high risk of bleeding (e.g. patients with prior upper gastrointestinal bleeding, Helicobacter pylori infection, advanced age, steroid treatment, and nonsteroidal anti-inflammatory drug use). DDIs could occur in an AIDS subpopulation treated with highly active antiretroviral therapy (HAART). DDIs exist for cancer patients undergoing targeted therapy. Hypomagnesemia could increase in the setting of advanced age and polypharmacy. Omeprazole poses high risks owing to its pharmacokinetic DDI profile. Future systematic reviews should incorporate these additional risks for better clinical guidance.
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http://dx.doi.org/10.1517/14740338.2016.1128413DOI Listing
October 2016

Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting.

J Pediatr (Rio J) 2015 Jul-Aug;91(4):392-6. Epub 2015 May 16.

Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.

Objective: Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea.

Methods: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1×10(8)CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded.

Results: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15h, 60.4±24.5h [95% CI: 51.0-69.7h] vs. 74.3±15.3h [95% CI: 68.7-79.9h], p<0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79, p<0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted.

Conclusion: L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.
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http://dx.doi.org/10.1016/j.jped.2014.10.009DOI Listing
January 2016

The effect of topical ethanol extract of Cotinus coggygria Scop. on cutaneous wound healing in rats.

Nat Prod Res 2016 16;30(4):452-5. Epub 2015 Mar 16.

b Clinical Pharmacy Department , Faculty of Pharmacy, Marmara University , Istanbul , Turkey.

The aim of this study is to determine the cutaneous wound healing effects of the ethanol extract of Cotinus coggygria leaves in rats by excision wound model to provide scientific evidence for the traditional use of C. coggygria Scop. The levels of malondialdehyde, catalase, superoxide dismutase, glutathione and hydroxyproline were investigated in wound tissues. Histopathological examination was also performed. The hydroxyproline content of the granulation tissue and the glutathione levels were both significantly higher in the treatment group than in the control group (p < 0.05 for both); while the malondialdehyde levels were significantly lower in the treatment group (p < 0.05). These results were supported with histological results. The ethanol extract of C. coggygria Scop could be considered as an effective agent in wound healing in accordance with its traditional use.
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http://dx.doi.org/10.1080/14786419.2015.1019349DOI Listing
October 2016

Ertapenem versus standard triple antibiotic therapy for the treatment of perforated appendicitis in pediatric patients: a prospective randomized trial.

Eur J Pediatr Surg 2014 Oct 27;24(5):410-8. Epub 2013 Aug 27.

Division of Pediatric Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Background: The primary objective of this study was to compare triple therapy with ertapenem treatments in pediatric patients with perforated appendicitis, especially in terms of postoperative infectious complications. The secondary objective of this study was to assess the relative impact of therapy with ertapenem and triple antibiotic regimen on the emergence of resistant bacteria in bowel flora in the patients.

Materials And Methods: Children aged 3 months to 17 years with perforated appendicitis were randomized 1:1 to receive ertapenem or triple therapy. Serial rectal cultures were obtained from participants enrolled in the study, allowing assessment of the relative impact of therapy with ertapenem and triple therapy on bowel colonization by resistant bacteria.

Results: In this study, 107 patients were included. No difference existed in time to full oral intake and regular diet, the length of antibiotic therapy, the length of the postoperative hospitalization, or the length of hospital stay between the two groups. Patients in the triple-therapy group were more likely to suffer from a postoperative infectious complication than those in the ertapenem group (6/54 vs. 2/53, p > 0.05). Bowel colonization with resistant organisms at the end of therapy in the triple-therapy group was significantly different than in the ertapenem group (35.2 vs. 11.3%, p < 0.05).

Conclusions: Bowel colonization with resistant bacteria was less likely to occur after ertapenem treatment than triple therapy. The results of this trial suggest that ertapenem may be a useful option that could eliminate the need for combination and/or multidosed antibiotic regimens for the empiric treatment of perforated appendicitis in children.
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http://dx.doi.org/10.1055/s-0033-1352524DOI Listing
October 2014

The effect of a multispecies synbiotic mixture on the duration of diarrhea and length of hospital stay in children with acute diarrhea in Turkey: single blinded randomized study.

Eur J Pediatr 2013 Apr 14;172(4):459-64. Epub 2012 Dec 14.

Department of Pediatrics, Pediatric Intensive Care and Infectious Disease Unit, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, TR26480, Turkey.

Probiotics have been successfully used for the treatment of acute diarrhea in children and this effect depends on the strains and dose. The aim of this study was to assess the effect of a synbiotic mixture on the duration of diarrhea and the length of hospital stay in children with acute watery diarrhea. This is a prospective randomized, multicenter single blinded clinical trial in hospitalized children with acute watery diarrhea. All children were treated with conventional hydration therapy with or without a daily dose of a synbiotic (2.5 × 10(9) CFU live bacteria including Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium longum, Enterococcus faecium, and 625 mg fructooligosaccharide) for 5 days. The primary endpoint was duration of diarrhea and duration of hospitalization was the secondary endpoint. Among 209 eligible children, 113 received the synbiotic mixture and 96 served as a control. The duration of diarrhea was significantly shorter (∼36 h) in children receiving the synbiotic group than the controls (77.9 ± 30.5 vs. 114.6 ± 37.4 h, p < 0.0001). The duration of hospitalization was shorter in children receiving the synbiotic group (4.94 ± 1.7 vs. 5.77 ± 1.97 days, p = 0.002). The effect of synbiotic mixture on diarrhea started after 24th hours and stool frequency significantly decreased after 24th and 48th hours. The percentage of diarrhea-free children is significantly higher in synbiotic group at 48th and 72nd hours of synbiotic group. In conclusion, this study showed a reduction in diarrhea duration by approximately 36 h and a reduction in the duration of hospitalization with approximately 1 day in children with acute diarrhea with this synbiotic mixture.
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http://dx.doi.org/10.1007/s00431-012-1903-5DOI Listing
April 2013

Assessment of medication knowledge and adherence among patients under oral chronic medication treatment in community pharmacy settings.

Pharmacoepidemiol Drug Saf 2013 Feb 18;22(2):209-14. Epub 2012 Apr 18.

Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey.

Purpose: This study aimed to determine whether there is a relationship between the lack of medication knowledge and the self-reported rates of patient medication adherence.

Methods: Patients eligible to participate in the study had been taking oral medication at least once daily over the course of a minimum of three consecutive months before recruitment to the study. All participants were older than 18 years. The level of each patient's knowledge of his or her medication was randomly assessed by a trained fifth-year pharmacy student through an adapted questionnaire. In addition, patient adherence was evaluated via utilization of the Morisky Medication Adherence Scale.

Results: Of the 765 study participants (mean ± SD age = 55.45 ± 15.05 years, range = 20-91 years, 56.2% women), 58.0% reported adherence to their medication regimen and 64.5% professed optimal knowledge of their medication. The mean duration of medication utilization was 26.77 ± 40.62 months (range = 3-504 years). A statistically significant correlation exists between the total medication knowledge score on the questionnaire and the level of medication adherence (r = -0.964, p < 0.001).

Conclusion: Improvement in the patient's knowledge of medications taken would bear a positive effect on medication adherence.
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http://dx.doi.org/10.1002/pds.3275DOI Listing
February 2013

Relationship between toll-like receptor 8 gene polymorphisms and pediatric pulmonary tuberculosis.

Dis Markers 2011 ;31(1):33-8

Sisli Etfal Training and Research Hospital, Division of Pediatric Infectious Diseases, Istanbul, Turkey.

Objectives: Genetic variants in Toll-like receptors (TLRs) are considered a potential indicator for host susceptibility to and outcome of several infectious diseases including tuberculosis. The aim of this study was to determine whether -129 C/G and Met1Val polymorphisms of TLR8 were associated with pediatric pulmonary tuberculosis in Turkish population.

Methods: The -129 C/G and Met1Val polymorphisms were studied in 124 children with pulmonary tuberculosis compared to 150 age-matched healthy control subjects.

Results: We did not identify any statistically significant differences between the patients with TB and control groups with regard to the frequency of genotypes GG or G/(-), CG, and CC or C/(-); and alleles G and C at rs3764879 (p> 0.05). We found a strong association with genotype A/(-) at rs3764880 with susceptibility to pulmonary TB in males (OR 2.87, 95%CI 1.38-5.98, p=0.007).

Conclusions: Our results provide evidence, for the first time, of a role for the TLR8 gene in susceptibility to pulmonary TB in male children. Additional research to verify our results are necessary. Tuberculosis in children presents particularly difficult challenges, but research priorities and advances in pediatric tuberculosis could provide wider insights and opportunities for tuberculosis control.
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http://dx.doi.org/10.3233/DMA-2011-0800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826908PMC
December 2011

Arg753Gln polymorphism of the human Toll-like receptor 2 gene from infection to disease in pediatric tuberculosis.

Hum Immunol 2011 May 12;72(5):440-5. Epub 2011 Feb 12.

Sisli Etfal Training and Research Hospital, Division of Pediatric Infectious Diseases, Istanbul, Turkey.

The aim of this study is to examine the occurrence of the Arg753Gln polymorphism of the Toll-like receptor 2 (TLR2) gene in Turkish children with pulmonary and/or extrapulmonary tuberculosis (TB) disease compared with that in healthy children with latent TB infection (LTBI) and to assess the risk of progression from LTBI to active TB disease in children. The Arg753Gln polymorphism of the TLR2 gene was studied in 198 TB patients compared with 200 ethnically and age-matched children with LTBI. The culture confirmed TB patients were more frequently Arg753Gln heterozygous [odds ratio (OR) 5.05, 95% confidence interval (95% CI) 2.61-9.76, p = 0.00], and Gln allele frequency was significantly higher in the patient group (13.86% vs 3.5%, OR 4.40, 95% CI 2.34-8.30, p = 0.00). We also showed that the frequencies of the heterozygous Arg753Gln genotype and the Gln allele were significantly higher in patients with pulmonary TB alone and in patients with definitive pulmonary plus extrapulmonary TB than in children with LTBI. Our data suggest that the Arg753Gln polymorphism of the TLR-2 gene influences the speed of progression from infection to TB disease in children. Further investigations are needed to clarify whether this polymorphism has a strong impact on susceptibility to TB in children.
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http://dx.doi.org/10.1016/j.humimm.2011.02.001DOI Listing
May 2011

Ertapenem for the treatment of urinary tract infections caused by extended-spectrum β-lactamase-producing bacteria in children.

Scand J Infect Dis 2011 May 28;43(5):339-43. Epub 2011 Jan 28.

Division of Paediatric Infectious Diseases, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Background: Urinary tract infections (UTIs) are a problem frequently encountered by paediatric healthcare providers. Recent data suggest that extended-spectrum β-lactamase (ESBL)-producing bacteria are an emerging cause of UTIs in non-hospitalized patients. We report our experience of ertapenem use in 50 patients with complicated UTIs, mainly pyelonephritis, caused by ESBL-producing organisms.

Methods: Fifty patients aged <16 y who had a complicated UTI caused by ESBL-producing organisms and who were treated with ertapenem at our hospital from 1 January 2009 to 31 December 2009, were included in the study.

Results: There were 20 (40%) males and 30 (60%) females with a mean ± standard deviation age of 38.6 ± 36.9 months (range 6-156 months). Twenty-eight patients had no urological abnormality. In 40 patients ertapenem was initiated after results of microbiological cultures became available. Ertapenem was initiated empirically for 10 patients known to be colonized with ESBL-producing bacteria. Urine cultures were negative at 3.3 ± 0.7 days (range 2-5 days) after starting ertapenem treatment. The mean duration of ertapenem treatment was 7.8 ± 1.2 days (range 7-14 days). No laboratory or clinical side effects were observed.

Conclusions: Ertapenem is promising for the culture-guided treatment of ESBL-producing Gram-negative complicated UTIs. Well-designed prospective studies are needed to define the role of ertapenem in treating complicated paediatric UTIs, especially upper UTIs.
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http://dx.doi.org/10.3109/00365548.2011.553241DOI Listing
May 2011

Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: are they effective?

Pediatr Int 2011 Oct;53(5):677-682

Divisions of Pediatric Infectious DiseasesClinical Microbiology, Sisli Etfal Training and Research Hospital, SisliDivision of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey.

Background: The aim of the present study was to evaluate the effectiveness of zinc, probiotic bacteria, and lactose-free formula and their different combinations in the treatment of rotavirus diarrhea in young children.

Methods: Eight different treatment groups were formed: group 1, 60 patients receiving Saccharomyces boulardii; group 2, 60 patients receiving zinc; group 3, 60 patients receiving lactose-free formula; group 4, 60 patients receiving S. boulardii plus zinc; group 5, 60 patients receiving S. boulardii plus lactose-free formula; group 6, 60 patients receiving zinc plus lactose-free formula; group 7, 60 patients receiving S. boulardii plus zinc plus lactose-free formula; group 8, 60 patients receiving only oral and/or parenteral rehydration solutions.

Results: No statistically significant differences were found in the time to resolution of fever after intervention between the treatment groups and the control group. The time to resolution of vomiting was significantly lower in group 4 compared with groups 1 and 5. The duration of diarrhea was significantly reduced in groups 2 and 4 compared to control. A statistically significant difference in the duration of hospitalization was observed for the groups 2 and 4 in comparison to the control group.

Conclusions: A different combination of adjunct therapies did not seem to bring additional value to rehydration therapy in children with rotavirus diarrhea except for in those receiving only zinc and zinc plus S. boulardii. Further studies are required to determine the optimal protocol of adjunct therapy use in children with rotavirus diarrhea.
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http://dx.doi.org/10.1111/j.1442-200X.2011.03325.xDOI Listing
October 2011